Pterygium

What is a pterygium? A pterygium (pronouned ter-ig-ee-um) (plural pterygia) is wedge-shaped fleshy growth of tissue, usually on the inner corner of the eye that can grow from the conjunctiva onto the cornea towards the pupil. It can affect one or both eyes.It is not a cancer and grows very slowly but if they are large enough, they can cause a reduction in vision.

A small pterygium may cause minimal or no symptoms and can be left alone, but as it grows can cause irritation and redness that can often be alleviated by lubricating eyedrops.

A larger pterygium can cause astigmatism by distorting the shape of the cornea and scarring which can obstruct vision.These should be surgically removed.

What causes a pterygium?Exposure to sunlight, especially ultraviolet rays plays the most important role in causing pterygia, although environmental irritants such as dust and wind can also be partly responsible. Pterygia are far more common in tropical climates and people at most risk are those that spend a lot of time or work outdoors, such as surfers, farmers and keen golfers.

How is a pterygium treated?In most cases a pterygium is treated conservatively. Artificial tears can be used to relieve the feeling of dryness and irritation. Occasionally a mild decongestant or an anti-inflammatory drop may be needed. Some pterygia eventually stop growing and thin down so they never need to be removed.Surgery, however is the only way to remove a pterygium.

When should surgery be considered?Surgery is not recommended unless a pterygium is causing significant problems such as:

1. A threat to normal vision by growing across the cornea towards the pupil enough to blur or obstruct vision.2. Causing astigmatism by distorting the shape of the cornea.3. Persistent irritation, watering or discomfort causing a gritty feeling or foreign body sensation.4. Redness—numerous blood vessels in the pterygium can make the eye recurrently or continually bloodshot.5. A pterygium can be unsightly and cosmetically unacceptable to the patient6. A pterygium can interfere with the comfortable wearing of contact lenses.

Pterygium Surgery

The surgery is performed under a local anaesthetic, usually at National Day Surgery in Kogarah.The procedure takes about 45 minutes and is painless as the eye is completely numb.You will probably be at the Day Surgery for about 3 hours including recovery and will need to have a carer and transport arranged as your eye will be padded. You will be reviewed by your surgeon the following day in the rooms at Hurstville Eye Surgery.

The operation involves lifting the pterygium free of the eye then peeling it off the cornea. Simply removing the pterygium carries a fairly high risk of recurrence. Therefore we perform a conjunctival autograft which almost eliminates the risk of recurrence.

This involves relocating a small very thin portion of healthy conjunctiva which is taken from high under the upper eyelid and measured to exactly fit the site of the excised pterygium. It is sutured in place with several very tiny stitches which normally dissolve.

As the eye can be quite sore for a few days afterwards, often a clear bandage contact lens is placed on the eye allowing healing and significantly reducing discomfort.

Before Pterygium surgery After surgery

After the surgery

• The eye may feel a bit scratchy while the stitches soften and dissolve.

• Your eye will be sensitive to light for about a week, so wear sunglasses to protect your eye from glare.

• You will have 2 different eye drops, an antibiotic, Chlorsig to protect against infection an anti-inflammatory, Prednefrin Forte, to settle the eye and help prevent recurrence.

• After a week the graft will become red and swollen and will then begin to settle and clear.You will be using eye drops in the eye for 4-6 weeks.

Pinguecula

A pinguecula (pronounced pin-gwek-you-la) (plural pingueculae) is similar to a pterygium but does not grow on to the cornea so cannot affect vision.

It is a yellowish thickening of the conjunctiva, also caused by excessive exposure to sunlight and can become red and inflamed at times.

It can be removed the same way as a pterygium but this is rarely necessary.

A pinguecula can usually be treated conservatively with lubricant drops and occasional anti-inflammatory drops.

Pinguecula